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                          <option>Juan Rodriguez</option>
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                          <option>Rojo</option>
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                      <h3>Datos del Cliente</h3>
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                        <select style="margin-right:10px;width:65px">
                          <option>21</option>
                        <select>
                        <select style="margin-right:10px;width:65px;">
                          <option>12</option>
                        <select>
                        <select style="width:70px;">
                          <option>1970</option>
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                          <option>DNI</option>
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                      <label style="float:left;margin-right:10px;padding-top:4px;">Tel&eacute;fono</label> 
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                  <!-- FECHA DE ENTREGA -->
                  <div class="table-bordered " style="z-index:99999;margin-top:30px;">
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                      <h3>Fecha de Entrega</h3>
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                      <label style="float:left;margin-right:10px;padding-top:4px;">Fecha</label> 
                      <div style="float:left;margin-right:100px;">
                          <select style="margin-right:10px;width:65px">
                            <option>15</option>
                          <select>
                          <select style="margin-right:10px;width:65px;">
                            <option>03</option>
                          <select>
                          <select style="width:70px;">
                            <option>2013</option>
                          <select>
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                      <label style="float:left;margin-right:10px;padding-top:4px;">Hora</label> 
                      <div style="float:left;margin-right:20px;">
                          <select style="margin-right:10px;width:65px">
                            <option>10</option>
                          <select>

                          <select style="margin-right:10px;width:65px;">
                            <option>30</option>
                          <select>
                          
                      </div>  
                    </div>
                  </div>
                  <!-- FIN FECHA DE ENTREGA -->
                  <!-- METODO DE PAGO -->
                  <div class="table-bordered " style="z-index:99999;margin-top:30px;">
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                      <h3>Forma de Pago</h3>
                    </div>
                    <div class="row " style="padding-left:40px;margin-top:20px;">
                      <label style="float:left;margin-right:10px;padding-top:4px;">M&eacute;todo</label> 
                      <div style="float:left;margin-right:100px;">
                          <select style="margin-right:10px;width:150px">
                            <option>Tarjeta Master Card</option>
                          <select>
                          
                      </div>
                      
                    </div>
                    <div class="row " style="padding-left:40px;margin-bottom:20px;">
                      <label style="float:left;margin-right:10px;padding-top:4px;">Importe</label> 
                      <div style="float:left;margin-right:100px;">
                       <input type="text" id="inputEmail" style="width:100px;" value="23500">  
                      </div>
                      
                    </div>
                  </div>
                  <!-- FIN METODO DE PAGO -->
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